Reflection One

Running head: REFLECTION ONE 1
Reflection One
Leah Will
Trent University
REFLECTION ONE 2
The first two weeks at my clinical placement for this semester have been great so far. I
am on the Forensic Reintegration to the Community Unit at Ontario Shores. We have completed
two shifts so far. The first shift was more of an orientation to the facility and the staff, as well as
the code of conduct and the various policies and procedures that are put in place for the safety of
the patients and the staff. Our second shift was a full shift on the unit. The day started at 7am
with report from the night shift nurses. I learned that this is when they report on any issues or
specific incidences that happened during the night. We were then paired up with a nurse for the
day and worked with the patients assigned to them. As I was not able to practice giving PO meds
yet, I started out the day shadowing my nurse who gave meds, including a q14D IM injection
that I was able to see.
The majority of my morning was spent in conference. This was a meaningful event as I
was able to sit in for about 2 hours an observe the process of what a conference is, and see
various interpersonal team members and their role in the meeting. At first, I felt very awkward
being there sitting around the table because I knew that I had nothing to contribute. I thanked
everyone for letting me sit in, learn and observe. To the best of my memory there was the charge
nurse, unit manager, an occupational therapist, psychiatrist and the primary nurse and selected
patient present in the meeting. One by one, a patient was brought up as a topic of discussion
regarding any changed in levels and privileges. Any concerns were also brought up to the
psychiatrist during this time, as well as discharge and housing plans for anyone who was leaving
the unit soon.
There was one patient that was brought in for conference that was in the care of the nurse
who I was working with that day, so I had become somewhat familiar with her general situation
after a brief chat that morning. She has a planned discharge in a few months and has been on the
REFLECTION ONE 3
list for housing, which finally got approved. However, the patient did not know that this had
gotten approved, and no one was to tell her yet. The conference was put in place to discuss a
behavior plan that was made for her following some aggressive behavior towards staff and other
patients. The patient did not handle this information well and was quite upset that she was given
a behavior plan. This was when it got very awkward for me, because I was sitting next to the
patient around the table. The patient began to yell at the psychiatrist, going off topic and trying to
get a change in medication.
The psychiatrist and the unit manager worked really well together to calm the patient
down and bring the focus back to the topic of discussion, which was her behavior plan. They
focused on points such as the fact that the patient needed to follow a behavior plan in order to
secure her spot in housing, despite the fact that she had already been approved, was just unaware.
It was interesting to see everyone work together in the best interest of the patient, even if this
meant that she was not to be told that the housing was approved for her. They wanted to make
sure the patient could focus on her behaviors and the associated consequence before thinking
about making a permanent discharge plan.
It was also interesting to see and hear the staff talking before and after the patient left the
conference room. Before the patient would enter with their nurse, the team would make a loose
plan as to what would be said and what kind of things to avoid saying. I remember one staff
member specifically saying to make sure we keep things positive, and make positive reinforcing
statements to the patient in case things go poorly. I also liked the short debrief at the end of the
meetings after the patient had left. The staff went over things that went well in the meeting and
some things, if any, that didn’t go to plan or could be improved for the next meeting with that
REFLECTION ONE 4
patient. Technicalities were also discussed and confirmed, such as level increases and changes to
privileges for some patients.
I remember studying this concept in past courses, where we don’t “lie” to the patient, but
we bend the truth or withhold certain information in the best interest of the patient as part of their
care plan. After this clinical day, I did go home and look up more information on the process of
forensic patients in a mental health facility, as well as more details regarding the Ontario Review
Board.
Reflecting on the situation and the patients very aggressive outburst during the
conference, I felt as if my past experience working in the emergency department with many
mental health patients really helped me stay calm and focused. I was able to put my emotions to
the side and really understand the underlying issues that the patient was bringing forward, and
has had in the past that could explain her behavior in this conference. Moving forward, I would
like to have more knowledge of the patients before the patient is brought into the conference.
This would help fill in any gaps that I may have before they arise. However, I feel as if this is
something I will come to learn as I continue to work with the patients and understand the
conference process better in the near future. I was really grateful that the staff allowed me to sit
in during this conference, as it was very instrumental in my learning, especially just having
started in this mental health placement.

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Running head: REFLECTION ONE 1

that I was able to see.

the unit soon.

get a change in medication.

about making a permanent discharge plan.

privileges for some patients.

started in this mental health placement.

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